Early and Mid-term Results of Endovascular Treatment of Abdominal Aortic Aneurysm in Patients Over 65 Years of Age
Abstract
Objective: In patients over the age of 65, the most appropriate treatment modality for abdominal aortic aneurysms (AAA) is controversial, but the use of endovascular treatment methods is increasing. The aim of this study was to investigate the duration of intensive care unit stay, need for reintervention, and early and late mortality rates after endovascular treatment in octogenerians with abdominal aortic aneurysm.
Material and Method: A total of 220 patients who underwent endovascular aneurysm repair for abdominal aortic aneurysm under elective conditions were included in the study. Patients over 70 years of age constituted Group-1 (n = 102) and those under 70 years of age constituted Group-2 (n = 118). The groups were analyzed in terms of postoperative intensive care stay, need for reintervention, and early and late mortality rates.
Results: The ratio of males was higher in group 1 (94.5% vs. 84.9, p = 0.017). Length of ICU stay was higher in group 1 (12 hours vs. 8 hours, p = 0.014). All four cases of early mortality were in patients over 65 years of age (p = 0.031). There was no difference between the groups in terms of follow-up period (32 vs. 31 months, p = 0.859), late mortality (8% vs. 13%, p = 0.219), or the need for secondary intervention (6% vs. 7%, p = 0.770). There was no difference between the groups in terms of survival and the 3-year survival was 91% vs. 85%. (p = 0.199).
Conclusion: In octogenerians, endovascular aneurysm repair can be performed with acceptable mortality rates and satisfactory mid-term outcomes.
Keywords
References
- Iscan HZ, Unal EU, Akkaya B et al. Color Doppler ultrasound for surveillance following EVAR as the primary tool.J Card Surg 2021;36:111-117.
- Lagergren E, Chihade D, Zhan H et al. Outcomes and Durability of Endovascular Aneurysm Repair in Octogenarians. Ann Vasc Surg 2019;54:33-39.
- Park BD, Azefor NM, Huang CC, Ricotta JJ. Elective endovascular aneurysm repair in the elderly: trends and outcomes from the Nationwide Inpatient Sample. Ann Vasc Surg 2014;28:798-807.
- Biancari F, Catania A, D’Andrea V. Elective endovascular vs. open repair for abdominal aortic aneurysm in patients aged 80 years and older: systematic review and meta-analysis. Eur J Vasc Endovasc Surg 2011;42:571e6.
- Rueda-Ochoa OL, van Bakel P, Hoeks SE et al. Survival After Uncomplicated EVAR in Octogenarians is Similar to the General Population of Octogenarians Without an Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2020;59:740-747.
- Wanhainen A, Verzini F, Van Herzeele et al.Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms.Eur J Vasc Endovasc Surg 2019;57:8-93.
- Western CE, Carlisle J, McCarthy RJ, Currie IC. Palliation of abdominal aortic aneurysms in the endovascular era. Eur J Vasc Endovasc Surg 2013;45:37e43.
- Han Y, Zhang S, Zhang J, Ji C, Eckstein HH. Outcomes of Endovascular Abdominal Aortic Aneuyrsm Repair in Octogenarians: Meta-analysis and Systematic Review. Eur J Vasc Endovasc Surg 2017;54:454-463.
- Geisbüsch P, Katzen BT, Tsoukas AI et al. Endovascular repair of infrarenal aortic aneuyrsm in octogenarians and nonoctogenarians. J Vasc Surg 2011;54:1605-1613.
- Patel R, Sweeting MJ, Powell JT, Greenhalgh RM; EVAR trial investigators. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomized controlled trial. Lancet 2016;388(10058):2366-2374.
- Pol RA, Zeebregts CJ, van Sterkenburg SM, Ferreira LM, et al. Outcome and quality of life after endovascular abdominal aortic aneurysm repair in octogenar- ians. J Vasc Surg 2014;60:308e17.
- P J Devereaux, Bruce M Biccard, Alben Sigamani et al, Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA 2017;317:1642-1651.
- VaitėnasG, Mosenko V, Račytė A, Medelis K, Skrebūnas A. Baltrūnas Abdominal Aortic Aneurysm Diameter versus Volume: A Systematic Review. T.Biomedicines 2023;11:941.
- Wanhainen A, Hultgren R, Linné A, et al. Outcome of the Swedish nationwide abdominal aortic aneurysm screening program. Circulation 2016;134:1141e8.
- Johansson M, Zahl PH, Siersma V, Jørgensen KJ, Marklund B, Brodersen J. Benefits and harms of screening men for abdominal aortic aneurysm in Sweden: a registry-based cohort study. Lancet 2018;391:2441e7.
- Fonseca R, Rockman C, Pitti A, et al. Intermediate-term EVAR outcomes in octogenarians. J Vasc Surg 2010;52:556e60.
Abstract
Amaç: 65 yaş üstü hastalarda abdominal aorta anevrizmalarının en uygun tedavi yöntemi tartışmalıdır, ancak endovasküler tedavi yöntemlerinin kullanımı artmaktadır. Bu çalışmanın amacı, abdominal aorta anevrizması olan 65 yaş üstü hastalarda endovasküler tedavi sonrası yoğun bakım süresini, yeniden müdahale ihtiyacını ve erken ve geç dönem mortalite oranlarını araştırmaktır.
Gereç ve Yöntem: Elektif koşullar altında abdominal aorta anevrizması için endovasküler anevrizma onarımı uygulanan toplam 220 hasta çalışmaya dahil edildi. 65 yaşın üzerindeki hastalar Grup-1'i (n = 102) oluştururken, 65 yaşın altındakiler Grup-2'yi (n = 118) oluşturdu. Gruplar, postoperatif yoğun bakım süresi, yeniden müdahale ihtiyacı ve erken ve geç dönem mortalite oranları açısından analiz edildi.
Bulgular: Erkeklerin oranı grup 1'de daha yüksekti (94.5% vs. 84.9, p = 0.017). Yoğun bakım süresi grup 1'de daha uzundu (12 saat vs. 8 saat, p = 0.014). Erken mortalite gerçekleşen dört vakanın tümü 65 yaşın üzerindeki hastalardaydı (p = 0.031). Gruplar arasında takip süresi (32 vs. 31 ay, p = 0.859), geç dönem mortalite (8% vs. 13%, p = 0.219) veya sekonder müdahale ihtiyacı (6% vs. 7%, p = 0.770) açısından fark yoktu. Gruplar arasında yaşam süresi ve 3 yıllık yaşam oranı açısından fark yoktu, 3 yıllık yaşam oranı ise %91 vs. %85'ti (p = 0.199).
Sonuç: Yaşlı hastalarda, endovasküler anevrizma onarımı kabul edilebilir mortalite oranlarıyla ve tatmin edici orta dönem sonuçlarıyla gerçekleştirilebilir.
Keywords
References
- Iscan HZ, Unal EU, Akkaya B et al. Color Doppler ultrasound for surveillance following EVAR as the primary tool.J Card Surg 2021;36:111-117.
- Lagergren E, Chihade D, Zhan H et al. Outcomes and Durability of Endovascular Aneurysm Repair in Octogenarians. Ann Vasc Surg 2019;54:33-39.
- Park BD, Azefor NM, Huang CC, Ricotta JJ. Elective endovascular aneurysm repair in the elderly: trends and outcomes from the Nationwide Inpatient Sample. Ann Vasc Surg 2014;28:798-807.
- Biancari F, Catania A, D’Andrea V. Elective endovascular vs. open repair for abdominal aortic aneurysm in patients aged 80 years and older: systematic review and meta-analysis. Eur J Vasc Endovasc Surg 2011;42:571e6.
- Rueda-Ochoa OL, van Bakel P, Hoeks SE et al. Survival After Uncomplicated EVAR in Octogenarians is Similar to the General Population of Octogenarians Without an Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2020;59:740-747.
- Wanhainen A, Verzini F, Van Herzeele et al.Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms.Eur J Vasc Endovasc Surg 2019;57:8-93.
- Western CE, Carlisle J, McCarthy RJ, Currie IC. Palliation of abdominal aortic aneurysms in the endovascular era. Eur J Vasc Endovasc Surg 2013;45:37e43.
- Han Y, Zhang S, Zhang J, Ji C, Eckstein HH. Outcomes of Endovascular Abdominal Aortic Aneuyrsm Repair in Octogenarians: Meta-analysis and Systematic Review. Eur J Vasc Endovasc Surg 2017;54:454-463.
- Geisbüsch P, Katzen BT, Tsoukas AI et al. Endovascular repair of infrarenal aortic aneuyrsm in octogenarians and nonoctogenarians. J Vasc Surg 2011;54:1605-1613.
- Patel R, Sweeting MJ, Powell JT, Greenhalgh RM; EVAR trial investigators. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomized controlled trial. Lancet 2016;388(10058):2366-2374.
- Pol RA, Zeebregts CJ, van Sterkenburg SM, Ferreira LM, et al. Outcome and quality of life after endovascular abdominal aortic aneurysm repair in octogenar- ians. J Vasc Surg 2014;60:308e17.
- P J Devereaux, Bruce M Biccard, Alben Sigamani et al, Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA 2017;317:1642-1651.
- VaitėnasG, Mosenko V, Račytė A, Medelis K, Skrebūnas A. Baltrūnas Abdominal Aortic Aneurysm Diameter versus Volume: A Systematic Review. T.Biomedicines 2023;11:941.
- Wanhainen A, Hultgren R, Linné A, et al. Outcome of the Swedish nationwide abdominal aortic aneurysm screening program. Circulation 2016;134:1141e8.
- Johansson M, Zahl PH, Siersma V, Jørgensen KJ, Marklund B, Brodersen J. Benefits and harms of screening men for abdominal aortic aneurysm in Sweden: a registry-based cohort study. Lancet 2018;391:2441e7.
- Fonseca R, Rockman C, Pitti A, et al. Intermediate-term EVAR outcomes in octogenarians. J Vasc Surg 2010;52:556e60.
Details
| Primary Language | English |
|---|---|
| Subjects | Cardiovascular Surgery |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | February 26, 2024 |
| Submission Date | September 13, 2023 |
| Acceptance Date | November 20, 2023 |
| Published in Issue | Year 2024 Volume: 6 Issue: 1 |
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